There’s been a small lapse…trips to Italy and all! So here we are back with some snappy #FOAMed #FOAMcc #POCUS finds and the usual trawl of the Twittersphere!

 

In other news!

Apparently we hit the dizzy heights of no. 17 amongst the top critical care sites online! Thanks to you all for clicking and following. I have to say, being under TBL / EMCrit etc is a privilege, but I reckon we have a way to go to get near to them for all of their hard work!

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Before you go on…

Check out Rob’s amazing picks of the latest papers. Loads of hard work as ever here. I normally feature a lot of these individually, but time floored me a tad!

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Check out what LITFL are saying this week.

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Papers

More on the diaphragm…focus your #POCUS here!

Another paper, but this time a meta analysis looking at the value of observation of diaphragmatic excursion on ‘wearability’. Read on…

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A bugger to treat and an even bigger bugger if you have it in the community!

This paper demonstrates the impact of this dis-electrolytosis (if that exists), on in hospital mortality when you might be afflicted in the community!

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Single may be better than a triple! Unless it’s Olympic medals we are talking about!

So addition of a more polypharmaceutical approach to COPD may not be as beneficial as first purported. Read here..

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It’s bad enough having an M.I…but then you get readmitted!

This review takes a useful look at what brings our patients, post-M.I, back into hospital again. There are some unexpected ones here too.

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Blogs

Beta blockers….again. POISE yourself!

The team at TBL take us through the results of a large beta blocker trial, recently completed. Was a metoprolol infusion of benefit to patients who were at risk of CVS events undergoing non-cardiac surgery? Read their brilliant review below.

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PE’s and DOAC’s…I love a rhyme!

Another good one from the crew here looking at ePESI scores and DOAC therapy. They seem to be pretty good at treating PE’s…of the lower risk variety.

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I’m allergic to oxygen, life and iodine!!!

The RebelEM crew discuss the old adage of iodine allergy and radio contrast. The pic gives it away but click on!

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MONA may be crap!

Take a look at this one from emlitofnote.com. Kind of takes apart what we all traditionally ploughed in to do for our infarct patients in the acute setting! I am amazed that even NYG had no overall positive outcome effect! While you are here…take a look at what the AVOID trial showed regarding O2 or SPO2 guided O2 only in evolving M.I.

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You have to get that Epi in!! But watch it in the elderly!

This blog from CoreEM discusses what we all may take for granted. In anaphylaxis, the key is to halt mast cell degranulation by giving epinephrine. We all give it IM, some can give it IV, but in the elderly giving it IV may be risky! Read on…

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#POCUS!

I found this fabulously simple mnemonic!!

Amazing way to scan your patient in shock…and even ascertain the cause. L.O.W.B.P

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B-Lines…scary B-lines!

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Look at what draining a pleural effusion can do to your diaphragm!

An interesting look at a small cohort of patients who had their fluid tapped off. What’s the diaphragm up to afterwards….they explain how US helped find the answer!

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Just occlude to collude with your fluid resuscitation!

Here is a nice paper from Critical care Medicine on the value of End Inspiratory and End Expiratory occlusion and it’s effect on VTI after fluid boluses. Will this trump IVC collapsibility analysis in the prediction of fluid responders? Read on…

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‘We feel your pain’!

A bit of a gospel read for all you POCUS fans…you will feel the pain as you scan through this brilliant article. I recommend you do…and persuade more to Learn POCUS!

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I can’t Stress enough the value of B lines!!

A snippet from an in press paper demonstrating the value of B-line count on lung US…even after stress echo performance. It demonstrates that a 4 point scan, Vs. the usual BLUE 3 point can dismiss dry from wet areas with good correlation using the third Intercostal Sace, along the Anterior Axillary line and Mid Axillary lines.

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Mets??

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Don’t be fooled!

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It’s a strain!

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Was it adenosine?

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Dialyse on those comets..

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What does Chiari look like?

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Top Tweets!

‘Ghali-Gosh’! He features a lot does Sam!

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And…..pause…

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There’s work afoot!

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My beating heart!

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Nice head injury guidance for you all!

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Top Mnemonics here!

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Why you need a capnograph!

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Fab Infographics!

Remember those volumes / capacities?!

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App of the week..

Download Sonoaccess to guide you through all that is POCUS. Excellent stuff. Link here..

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That’s it for now. Jonathan Downham and I will be bringing you the Two Jonnys podcast soon.

JW Sept 4th 2017